Abstracts

Rationale: Depressive symptoms in YWE continue to be under-recognized and under-treated. Only ?1/3 YWE with comorbid psychopathology receive mental health care. Further, seminal papers encourage assessment for depression and suicidality beginning at initial epilepsy diagnosis and urge comorbidities must be treated to increase quality of life for YWE. Despite these recommendations, Gilliam (1) reports that 80% of neurologists do not routinely screen for depression in patients with epilepsy and developed the NDDI-E to increase adult screening. In light of the discrepancy between prevalence rates for depressive symptoms in YWE and diagnosis and treatment of these symptoms, we performed a study to 1) modify the NDDI-E screening tool for youth (NDDI-E-Y), 2) validate the NDDI-E-Y, and 3) facilitate access to mental health care providers and assess barriers. Methods: Basic demographic and seizure-related information was collected on all participants. 31 YWE were administered the NDDI-E-Y a second time, an average of 15 days later. The NDDI-E-Y has 11 items, with responses always/often , sometimes , rarely , and never , given scores of 4 through 1, respectively. Individual item scores for 1st and 2nd testing were compared using weighted kappa statistics. Sums of total scores were compared using Spearman correlation. YWE were referred for further evaluation if ? 7 items were endorsed as always/often or item 6 ( I d be better off dead ) was endorsed - this was dichotomized into yes/no for referral, and 1st and 2nd testing compared using kappa statistic. Finally, total score was dichotomized into greater than 27 or not, and 1st and 2nd testing also compared. Results: Participants taking a retest of the NDDI-E-Y were 61% female, 71% white and 29% black, ranged in age from 10 to 17, with average age of 15 years. 84% were taking 1 or 2 antiepileptic medications and 2 had a VNS. Most youth had partial epilepsy with impairment of consciousness (68%), with 25% having generalized nonconvulsive epilepsy, and the remainder having generalized convulsive epilepsy. The mean total score was 23 on the initial test, and 22 on the retest. Kappa scores of individual items ranged from 0.16 to 1.00, with an average of 0.48. Two items with perfect agreement were I feel guilty and I have difficulty finding pleasure . Spearman correlation of initial and retest total scores was 0.71 (p<.0001). Scores dichotomized for referral had a kappa value of 0.65, showing good agreement. Total scores dichotomized at score of 27 had a kappa value of 0.89, showing excellent agreement. Conclusions: Initial results are promising and require further refinement and testing. Further analysis on the 93 youth will compare NDDIE-Y results with the Depressive Disorders module of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present (K-SADS-P). The NDDIE-Y may provide an efficient way to screen for depressive symptoms in YWE. Previous research has indicated early identification and intervention can lead to prevention of depression. A brief tool to use in the clinic setting would be an innovative way to begin this process.